Power is an inescapable aspect of all socialrelationships, and inherently is neither goodnor evil. Doctors need power to fulfil theirprofessional obligations to multipleconstituencies including patients, thecommunity and themselves. Patients need powerto formulate their values, articulate andachieve health needs, and fulfil theirresponsibilities. However, both parties canuse or misuse power. The ethical effectivenessof a health system is maximised by empoweringdoctors and patients to develop `adult-adult'rather than `adult-child' relationships thatrespect and enable autonomy, accountability,fidelity and humanity. Even in adult-adultrelationships, conflicts and complexitiesarise. Lack of (...) concordance between doctors andpatients can encourage paternalism but may bebest resolved through negotiated care. Afurther area of conflict involves the `doubleagency' of doctors for both patients and thecommunity. Empowerment of all players is notalways possible but is most likely where eachparty considers and acknowledges power issues. (shrink)

The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. (...) Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce. (shrink)

Person-centered care offers a promising way to manage clinicians’ conscientious objection to providing services they consider morally wrong. Health care centered on persons, rather than patients, recognizes clinicians and patients on the same stratum. The moral interests of clinicians, as persons, thus warrant as much consideration as those of other persons, including patients. Interconnected moral interests of clinicians, patients, and society construct the clinician as a socially embedded and integrated self, transcending the simplistic duality of private conscience versus public role (...) expectations. In this milieu of blurred boundaries, person-centered care offers a constructive way to accommodate conscientious objection by clinicians. The constitutionally social nature of clinicians commits and enables them, through care mechanisms such as self-care, to optimize the quality of health care and protect the welfare of patients. To advance these conditions, it is recommended that the medical profession develop a person-centered culture of care, along with clinician virtues and skills for person-centered communication. (shrink)

Modern technologies sanction a new plasticity of physical form. However, the increasing global popularity of aesthetic procedures produces normative beauty ideals in terms of perfection and symmetry. These conditions limit the semblance of freedom by people to control their own bodies. Cultural emancipation may come from principles in Eastern philosophy. These reveal beauty in authenticity, including imperfection. Wabi-sabi acclaims beauty in common irregularity, while kintsugi celebrates beauty in visible signs of repair, like scars. These principles resist pressure to medicalize dissatisfaction (...) with healthy bodies and invite multi-sited interventions to educate taste and aesthetic choices. (shrink)

Cooperation and conversation in the public sphere may overcome historical and other barriers to rational argumentation. As an alternative to evidence-based medicine (EBM) and patient-centered care (PCC), the recent development of a modern version of person-centered medicine (PCM) signals an opportunity for a conversational pluralogue to replace parallel monologues between EBM and its critics, and the calls to EBM to debate its critics. This article draws upon elements of Habermas’s theory of communicative action in order to suggest the kind of (...) pluralogue that is required for stakeholders in modern medicine to benefit more from publicly conversing with each other than speaking alone or using debate to argue against each other. This reasoned perspective has lessons for all discourse when deep value-based and epistemological differences cannot be easily adjudicated. (shrink)

Body image research focuses almost exclusively on women or overweight and obesity or both. Yet, body image concerns among thin men are common and can result, at least in part, from mixed messages in society around how men qua men should dress and behave in order to look good and feel good. Stand-alone interventions to meet these different messages tend to provide men with little therapeutic relief. This conceptual paper draws on literature from the medical humanities; gender and body image (...) studies; the social psychology of clothing; and the author’s own lived experience to address this contemporary problem. The paper embraces visual culture as a resource that can frame discussion of how two sets of ‘performativity’ might reduce male anxiety about thinness. First, thin men could choose repeatedly to wear masculine-looking clothing, which could create their masculinity as a personal aesthetic that strengthens the confidence to harness masculine traits in healthy ways. Secondly, health and allied health service providers could promote and reinforce such dress behavior by offering advice that integrates aesthetic and functional aspects of clothing. Empirical studies are needed to test this dual model of performativity. (shrink)

New Zealand and United Kingdom governments have set new directives for increased consultation with the public about health care. Set against a legacy of modest success with past engagement with public consultations, this paper considers potentially adverse ethical implications of the new directives. Drawing on experiences from New Zealand and the United Kingdom, and on an Orthodox Jewish perspective, the paper seeks to answer two questions: What conditions can compromise the ethics of public consultation? How can the public respond ethically (...) to consultation? In answering these questions, the paper considers how Orthodox Judaism, as a specific positive morality, can aid the development of public policy. It is suggested that an Orthodox Jewish perspective does not require limiting the content of public consultations and helps to define a common procedural morality binding Jews and non-Jews. This procedural morality requires avoiding two conditions that, as shown from Jewish texts, make public consultation unethical. These are overpreparation and underpreparation. Members of the public who deem a consultation unethical should give feedback not on the proposal but on the conditions they perceive to prevent the consulting party from considering their viewpoints on the proposal. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

What could someone represent that would enable her to track, at least within limits, others' perceptions, knowledge states and beliefs including false beliefs? An obvious possibility is that she might represent these very attitudes as such. It is sometimes tacitly or explicitly assumed that this is the only possible answer. However, we argue that several recent discoveries in developmental, cognitive, and comparative psychology indicate the need for other, less obvious possibilities. Our aim is to meet this need by describing the (...) construction of a minimal theory of mind. Minimal theory of mind is rich enough to explain systematic success on tasks held to be acid tests for theory of mind cognition including many false belief tasks. Yet minimal theory of mind does not require representing propositional attitudes, or any other kind of representation, as such. Minimal theory of mind may be what enables those with limited cognitive resources or little conceptual sophistication, such as infants, chimpanzees, scrub‐jays and human adults under load, to track others' perceptions, knowledge states and beliefs. (shrink)

What could someone represent that would enable her to track, at least within limits, others' perceptions, knowledge states and beliefs including false beliefs? An obvious possibility is that she might represent these very attitudes as such. It is sometimes tacitly or explicitly assumed that this is the only possible answer. However, we argue that several recent discoveries in developmental, cognitive, and comparative psychology indicate the need for other, less obvious possibilities. Our aim is to meet this need by describing the (...) construction of a minimal theory of mind. Minimal theory of mind is rich enough to explain systematic success on tasks held to be acid tests for theory of mind cognition including many false belief tasks. Yet minimal theory of mind does not require representing propositional attitudes, or any other kind of representation, as such. Minimal theory of mind may be what enables those with limited cognitive resources or little conceptual sophistication, such as infants, chimpanzees, scrub-jays and human adults under load, to track others' perceptions, knowledge states and beliefs. (shrink)

BackgroundLittle is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program.MethodsThe objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at (...) a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed.ResultsAll 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2–9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2–7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified.ConclusionsThis study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum. (shrink)

The unique discourse of Confucian ritual practice encompasses a powerful and sophisticated way of talking about individual fulfillment within the context of more substantive or universal conceptions of the good life. To make this case, I will consider both the text of the "Analects" and the influential readings of the "Analects" offered by Fingarette in "Confucius: The Secular as Sacred" and by Hall and Ames in "Thinking through Confucius". Though the two interpretive works are helpful in articulating the classical Confucian (...) contribution to the problem of balancing conformity and individuality, I will argue that an alternative reading is required to appreciate fully how values thought to embody and express the fullest humanity might be inculcated in ethical agents without undoing their individuality. Such an alternative is developed here. (shrink)

Many of the things we do are, or could be, done with others. Mundane examples favoured by philosophers include painting a house together (Bratman 1992), lifting.

Three experiments investigated response times for remember and know responses in recognition memory. RTs to remember responses were faster than RTs to know responses, regardless of whether the remember–know decision was preceded by an old/new decision or was made without a preceding old/new decision . The finding of faster RTs for R responses was also found when remember–know decisions were made retrospectively. These findings are inconsistent with dual-process models of recognition memory, which predict that recollection is slower and more effortful (...) than familiarity. Word frequency did not influence RTs, but remember responses were faster for words than for nonwords. We argue that the difference in RTs to remember and know responses reflects the time taken to make old/new decisions on the basis of the type of information activated at test. (shrink)

Drawing on Protestant scholasticism, Puritan "precisionism," and virtue ethics, "Virtue Reformed" offers a comprehensive rereading of the ethical position of ...

In this paper I offer an analysis of, and suggest some methods for dealing with, a quite particular and peculiar problem in teaching philosophy. It is, perhaps,not a problem essential to the discipline or to its teaching, but it is nevertheless one of the most serious, pervasive, and frustrating problems confronting mostphilosophy teachers today. I speak of the problem of student relativism-or, SR for short.

The development of children’s minds raises fundamental psychological and scientific questions, from how we are able to know about and describe basic aspects of the world such as words, numbers and colours to how we come to grasp causes, actions and intentions. This is the first book to properly introduce and examine philosophical questions concerning children’s cognitive development and considers the implications of scientific breakthroughs for the philosophy of developmental psychology. Each chapter explores a central topic in developmental psychology from (...) a philosophical perspective: social interaction and the developing mind children's awareness of objects and the question of 'object permanence' knowledge of numbers children and the acquisition of knowledge of colour language acquisition and the 'mapping problem' children's knowledge of the relation between actions and goals belief acquisition and the developing mind. Throughout the book Stephen Butterfill draws on several important case studies, including experiments with children on memory, ‘false belief tasks’, and the process by which children come to see other people, not just themselves, as capable of experience. He shows how these questions can illuminate some fundamental debates in philosophy of mind, such as the mind’s possession of concepts, rationality and the mind, the possibility of objective thought, and the nature of perceptual experience. Additional features, such as chapter summaries, annotated further reading and a glossary provide helpful tools for those coming to the subject for the first time. (shrink)

Scientific peer reviewers play an integral role in the grant selection process, yet very little has been reported on the levels of participation or the motivations of scientists to take part in peer review. The American Institute of Biological Sciences developed a comprehensive peer review survey that examined the motivations and levels of participation of grant reviewers. The survey was disseminated to 13,091 scientists in AIBS’s proprietary database. Of the 874 respondents, 76% indicated they had reviewed grant applications in the (...) last 3 years; however, the number of reviews was unevenly distributed across this sample. Higher review loads were associated with respondents who had submitted more grant proposals over this time period, some of whom were likely to be study section members for large funding agencies. The most prevalent reason to participate in a review was to give back to the scientific community and the most common reason to decline an invitation to review was lack of time. Interestingly, few suggested that expectation from the funding agency was a motivation to review. Most felt that review participation positively influenced their careers through improving grantsmanship and exposure to new scientific ideas. Of those who reviewed, respondents reported dedicating 2–5% of their total annual work time to grant review and, based on their self-reported maximum review loads, it is estimated they are participating at 56–87% of their capacity, which may have important implications regarding the sustainability of the system. Overall, it is clear that participation in peer review is uneven and in some cases near capacity, and more needs to be done to create new motivations and incentives to increase the future pool of reviewers. (shrink)

Developed as the text for the basic computer architecture course at MIT, Computation Structures integrates a thorough coverage of digital logic design with a comprehensive presentation of computer architecture.

Well over five thousand languages are known to exist or to have existed in the world, but hundreds of these are no longer living languages used by speakers and speech communities in their day-to-day activities and lives. Some of them lead a pseudolife as revered monuments of the past which still have some restricted and specialised roles to play today, such as Latin, Ancient Greek, Church Slavonic and others, but most of them are of interest and concern only to a (...) small group of linguists, historians and some other experts who look at the past. Many languages have disappeared without being known to us in any great detail, with only some fragmentary materials in them - written or noted down by speakers or observers of them hundreds or even thousands of years ago - at our disposal to give us some idea as to what those languages were like. Others have disappeared without even that scanty information about their nature being available to us; only their names are known from historical records, or perhaps some remarks were written down by someone many years ago and were preserved over the ages to tell us something about some special features of such a language or such languages and who and what kind of people their speakers were. Many other languages, certainly a much larger number than the dead languages about which we know something, have disappeared without our knowing anything of or about them. (shrink)

Clearchus of Soloi, a junior colleague of Aristotle's, devoted a work in at least two books to the topic of eros. Like most of what survives from his once substantial corpus, the remains of this work display wide learning, especially in history and literature, and a moralizing orientation. The work did not circulate widely; all that survives is a handful of passages in Athenaeus (frs. 21-35 Wehrli), most very brief. That is far too little to permit any reconstruction of its (...) overall structure or scope. But some of its interests and themes can be recovered. Clearchus discussed love, especially between the sexes, with more sympathy and subtlety than previous scholarship has recognized. His work on eros also appears to have been largely in tune with trends in early Hellenistic poetry. (shrink)

The Journal of "Religious Ethics" marks the tercentenary of Edwards's birth with the following collection of essays. In keeping with the overall mission of the journal, this tribute takes the form of historical and constructive reflection, in which diverse perspectives on Edwards's work and diverse forms of engagement with it supplement and correct one another. Our hope is that these essays will serve both to generate interest in Edwards's work among those who are unfamiliar with him, and to advance the (...) discussion of central issues in theological and religious ethics. In this introductory essay, we will offer some reflections on Edwards's general significance for contemporary ethics, followed by a closer examination of his main texts and a brief summary of the essays collected here. (shrink)

In animal cells, the Golgi complex undergoes reversible disassembly during mitosis. The disassembly/reassembly process has been intensively studied in order to understand the mechanisms that govern organelle assembly and inheritance during cell division. A long‐standing controversy in the field has been whether formation of Golgi structure is template‐mediated or self‐organizes from components of the endoplasmic reticulum. A recent study1 however, has demonstrated that a subset of proteins that form a putative Golgi matrix can be inherited during cell division in the (...) absence of membrane input from the endoplasmic reticulum. The outcome of this study suggests that a templating mechanism for the formation of Golgi structure may exist. This study has important implications for understanding mechanisms that govern Golgi biogenesis. BioEssays 24:584–587, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

Over the last twenty-five years, Stephen Resnick and Richard Wolff have developed a groundbreaking interpretation of Marxian theory generally and of Marxian economics in particular. This book brings together their key contributions and underscores their different interpretations. In facing and trying to resolve contradictions and lapses within Marxism, the authors have confronted the basic incompatibilities among the dominant modern versions of Marxian theory, and the fact that Marxism seemed cut off from the criticisms of determinist modes of thought offered (...) by post-structuralism and post-modernism and even by some of Marxisms greatest theorists. (shrink)

As the last century of the present millennium is drawing to a close and the first century of the next one is looming on the horizon, linguistics and the fate of many of the 6000 languages on our planet is poised on a watershed, looking at a changing future.

Pidgin languages are generally languages which are more or less rudimentary languages developing in situations of contacts between two different cultures, one of them dominant in the contact situation, with the use of such languages restricted to certain limited contacts such as trading, plantation work involving the employment of indigenous labour, master-servant relationships, and similar types of contact situations. Much of the vocabulary of a pidgin language consists of elements of the language of the dominant culture in a more or (...) less distorted, and often semantically changed, form with elements from the language of the non-dominant culture playing a less important part in its vocabulary. Its structural features do not as a rule reflect structural characteristics of the language of the dominant culture, unless the languages of both the dominant and the non-dominant culture are closely related and structurally very similar, though even in such situations quite significant deviations from the structural set-up of the language of the dominant culture can be observed in the pidgin language. Some to many of the structural features of a pidgin language may reflect features of the language of the non-dominant culture but, in pidgin languages, a number of unique structural and grammatical features can be observed which appear to reflect some basic simplifications in language use in contact situations between speakers of different languages. In any event, in the usual type of pidgin language, the overall vocabulary is small and limited in its usefulness to the specific types of contact situations in which the language is used and its grammatical complexity is greatly reduced when compared with both the language of the dominant culture and the nondominant culture. Also, as a rule, the sound system of a pidgin language constitutes a considerable simplification when compared with the sound system of both these languages. (shrink)

In Silence et langage Stephen A. Noble offers a new interpretation of the development of Merleau-Ponty’s phenomenology which analyses the central position of language within a philosophy of perception predicated upon the interdependence of seeing and speaking.